Archived: Divinus Support Ltd

Divinus is a domiciliary care service providing personal care to people in their own homes. Not everyone who used the service received personal care. In this service, the Care Quality Commission can only inspect the service received by people who get support with personal care. This includes help with tasks related to personal hygiene and eating. Where people receive such support, we also consider any wider social care provided. At the time of this inspection there were 18 people using the service, 13 of which were in receipt of personal care.

People’s experience of using this service and what we found

At the time of the inspection, the location did not care or support for anyone with a learning disability or an autistic person. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group.

Right Support:

People were exposed to risk of harm as systems to ensure the safe and proper management of medicines were inadequate. Since our last inspection care plans and risk assessments continued to lack robust and clear guidance, with incorrect or conflicting information. Risk assessments continued to fail to direct staff on recognising symptoms of known health conditions.

Staff had not always been safely recruited. References had not always been appropriately obtained and we were not assured staff had access to training.

Right Care:

Staff call monitoring systems were not always effective to ensure safe care delivery. The provider could not be assured people received their care calls as expected as there was a lack of monitoring. The provider was not monitoring care records to ensure people received kind and caring support.

Right Culture:

Governance systems remained inadequate, and the service was not well-led. The provider failed to carry out their regulatory responsibilities and did not have adequate oversight of the service. They lacked recognition and understanding of risk and subsequently lacked robust assessments and controls to protect people and keep them safe. There was a high number of incidents requiring police intervention and a failure to identify and act on where things were going wrong.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update: The last rating for this service was inadequate (published 28 December 2022)

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions safe and well led which contain those requirements.

We have found evidence that the provider still needed to make improvements. Please see the safe and well led sections of this report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Divinus Support ltd on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified continued breaches in relation to staff training, safeguarding, recruitment and oversight and management of the service.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service therefore remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in ‘special measures’ will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it, and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Divinus is a domiciliary care service providing personal care to people in their own homes. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. At the time of this inspection there were 29 people using the service, 18 of which were in receipt of personal care.

People’s experience of using this service and what we found

Whilst people told us their needs were met by caring and respectful staff, the registered manager could not assure themselves that staff had the right skills, experience, knowledge or competency. This was because not all staff had received the training they required for the role they were employed to perform, or had their competency assessed to deliver safe care and treatment.

Recruitment processes were not robust. Recruitment checks had not been completed on all new staff to check their suitability or competence to work with people prior to commencing employment.

Full recruitment checks as required by law had not been completed on all staff further contributing to the failure of the registered manager in seeking assurances on the suitability of staff and ensuring a safe service.

Staff had not been trained to recognise and report abuse appropriately.

Risks to people from receiving unsafe care and support were not always assessed with risk management plans in place. Care plans did not always reflect actions for staff to take to reduce the risk of harm.

Further work was needed to ensure medicines were well managed. Not all staff employed had been trained to administer people's prescribed medication safely, and their competency had not been assessed.

Governance arrangements continued not to provide assurance that the service was well-led.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests. However, staff were not provided with training in understanding their roles and responsibilities in relation to the Mental Capacity Act (2005) MCA.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 25 June 2021). There was a breach of regulation. The service has deteriorated to inadequate. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

Why we inspected

We carried out an announced comprehensive inspection of this service on 21 April 2021. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve staffing and recruitment.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions safe and well led which contain those requirements.

The overall rating for the service has deteriorated to inadequate.

We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Divinus Support Ltd on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to staff training, safeguarding, recruitment and oversight and management of the service.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Divinus Support Ltd is a domiciliary care agency providing personal care to people living in their own homes. At the time of inspection, the service was providing the regulated activity of ‘personal care’ to 32 people.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

People’s experience of using this service and what we found

We found that staff did not receive all the training they needed to deliver high quality care. Staff recruitment was now safe and in line with regulation. Governance arrangements did not provide assurance that the service was well-led.

People were satisfied with their care and support. People said that the service had become more reliable in recent months. People described the care staff as kind, caring and they felt safe being supported by staff from Divinus Support.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

This service was registered with us on 15 March 2019 and this is the first rated inspection.

The last rating for the service under the previous provider was Requires Improvement, (published on 4 April 2019). We completed a targeted inspection on 21 January 2021 due to concerns raised. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of those regulations.

Why we inspected

This inspection was to check whether the Warning Notice we previously served in relation to Regulation 17 (1) (2) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met and to formally rate this service.

We have found evidence that the provider needs to make improvement. Please see the safe and well led sections of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service to keep people safe and to hold providers to account where necessary.

We have identified breaches in relation to staff training.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Divinus Support Ltd on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Divinus Support Ltd is a domiciliary care agency providing personal care to people living in their own homes. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. At the time of our visit 37 people were receiving personal care from the service.

People’s experience of using this service and what we found

We received information raising concerns how people using the service were being kept safe. This related to staffing and recruitment processes.

We found concerns relating to the safe recruitment of staff. This had led to potentially inappropriate staff being employed. These concerns were not identified by the registered manager because the policy and procedures in place for recruitment was unsuitable and had not been reviewed.

There was a lack of systematic overview of the quality of care being provided. Updated policies and procedures were not in place. The updated policy on infection control was not forth coming despite being requested. Auditing was lacking in areas such as medicines management. Despite this we did not identify a negative impact on people. Peoples views were sought but there was a lack of planned action to improve the service based on their feedback.

People’s experience was mixed in terms of consistent reliable staff. Half of the people told us they had a small group of staff that they knew who arrived on time and stayed the length of time people needed them. Others were satisfied but didn’t always know who or when staff would arrive to support them. One person’s breakfast visit had slowly moved to 11am from 10am. People were complimentary about the staff and all said they felt safe with staff. One person said, “I’m pleased with my carers; most are good and most go out of their way to help.” People also felt the registered manager was accessible to them and were confident to contact them if needed.

People told us staff were well trained and knew their job. This included the recent changes around personal protective equipment (PPE) and keeping COVID-19 at bay. One person said, “They all wear mask, gloves and aprons.” Staff we spoke with corroborated that they had good training alongside the ‘boss’ and were always provided with enough PPE and given updated guidance electronically sent to them.

People confirmed they received their medicines when needed. Others spoke of how they were enabled to remain independent with medicines administration.

Rating at last inspection

This service has yet to be formally rated.

Why we inspected

We undertook this focused inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in response to concerns received about staffing and recruitment. A decision was made for us to inspect and examine those risks. Please see the safe and well led sections of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to keeping people safe and provider oversight of the service at this inspection. Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.